EPV1343 - Risperidone-Induced Agranulocytosis in a Young Patient With Schizophrenia: A Case Report
EPV1343
Risperidone-Induced Agranulocytosis in a Young Patient With Schizophrenia: A Case Report
O. Seyar 1,*, L. Azizi 1, Z. Bencharfa 2, F. El Omari 1
1psychiatry, 2Arrazi hospital, Salé, Morocco
Introduction: Risperidone is a widely prescribed atypical antipsychotic. Hematological adverse effects, although well documented with clozapine, are rarely associated with risperidone. We present a case of recurrent risperidone-induced agranulocytosis in a young patient with schizophrenia.
Objectives: To describe a rare case of risperidone-induced agranulocytosis in a young patient with schizophrenia, to explore its possible immuno-allergic mechanism, and to highlight the importance of hematological monitoring during antipsychotic treatment.
Methods: A 23-year-old Moroccan male with a 5-year history of schizophrenia and no relevant medical history was treated with risperidone after inadequate response to olanzapine. The dose was increased from 2 to 6 mg within four days, with good initial efficacy. Clinical monitoring and serial complete blood counts (CBC) were performed throughout treatment and rechallenge.
Results: Six weeks after risperidone initiation, progressive leukopenia and neutropenia were observed, with neutrophils falling to 750/µL after two months, leading to drug discontinuation. Chlorpromazine was also stopped, and aripiprazole (15 mg/day) was introduced, resulting in hematological recovery but poor clinical response. Risperidone rechallenge under daily CBC monitoring caused a more rapid recurrence of neutropenia within one week, supporting an immune-allergic mechanism. Alternative explanations such as ethnic neutropenia, margination, or concomitant medications (chlorpromazine, hydroxyzine) were excluded. A literature review identified 27 similar cases of risperidone- or paliperidone-induced neutropenia. This case illustrates the rare but serious risk of risperidone-induced agranulocytosis. The accelerated recurrence upon rechallenge strongly suggests hypersensitivity rather than dose-related toxicity. Although considered rare by pharmacovigilance reports, this adverse effect may lead to severe infectious complications if unrecognized.
Conclusions: Baseline and follow-up CBC monitoring should be performed after risperidone initiation, even though hematological toxicity is uncommon. The use of long-acting risperidone formulations should be delayed until tolerance to the oral form is established.
Disclosure of Interest: None Declared